Multidetector computed tomography of spinal and pelvic fractures : with special reference to polytrauma patients
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Serious injuries of the spine and pelvis are common in level I trauma centers, and are usually the result of high-energy accidents such as motor vehicle accidents (MVA) or falls from a height, but increasingly also sports and recreational accidents. Even presumably minor accidents can result in serious injury depending on the injury mechanism. The risk of acquiring a fracture is also tied to possible predisposing factors such as a weakened bone structure in osteoporosis, or an increased stiffness of the spine in ankylosing spondylitis. ----- Spinal injuries have a potential for catastrophic, life-altering consequences, because they are associated with spinal cord injury (SCI). A missed or inappropriately managed spinal injury can result in secondary SCI or progression of the initial damage. But also pelvic fractures pose a serious threat, as there are large-caliber blood vessels, nerves, and the lower urinary tract in close proximity to the pelvic bones. An acute bleeding into the pelvic area can remain clinically silent for an extended amount of time due to circulatory compensation processes. Exclusion of these occult injuries by imaging techniques is therefore imperative in order to detect a serious injury as early as possible and administer appropriate treatment. Time-, space-, and cost restraints as well as the patient s stability limit the application of imaging modalities in the golden hour of trauma resuscitation, which is arguably the most critical phase for the patient s outcome. The optimal choice of imaging methods is therefore crucial. But also the knowledge of injury patterns and demographic risk factors contributes to the correct diagnosis of a serious injury. This thesis focuses on injury patterns of the spine in conjunction with high-energy accidents, as well as demographic patterns and the optimal choice of imaging modality. It consists of five publications with a total of 2375 patients, covering a time frame from January 2001 to September 2009. There is special emphasis on vertebral burst fracture, which is the most common fracture in the thoracolumbar area, and which has furthermore a high potential for SCI due to its unstable nature. Also the bony pelvis as an extension of the spine receives special reference. According to our results, serious spinal injury as a result of blunt trauma occurs in all age groups and independently of gender, and even minor trauma energies can result in serious trauma. Trauma energy does have an influence though, as the incidence of spine fractures increases with increasing falling height, and burst fractures and spine fractures on multiple levels become more frequent. But also other blunt trauma mechanisms had multiple spine fractures in up to 32 % of cases, whereof 29 % were non-contiguous. Burst fracture was seen on multiple levels in 10 % of cases, with 50 % being non-contiguous. The frequent occurrence of vertebral fractures and especially burst fractures on non-contiguous levels makes imaging of the whole spine necessary in conjunction with high-energy accidents, especially in obtunded patients. Radiography demonstrates unstable vertebral fractures with acceptable accuracy, particularly in the lumbar spine (LS). Summation of overlapping tissue in these areas makes the identification of the hall marks of an unstable facture difficult, which can lead to an injury being missed, or wrongly classified as stable. Neurological deficit was most frequent and serious in the CS. In the pelvic area, radiography detected only 55 % of fractures diagnosed by multidetector computed tomography (MDCT), and in 11 % findings were false negatively normal. Additionally, Tile classification of fractures was correct in 59 % of injuries, whereas the subtype was correct in only 14 %. The pelvis was false negatively classified as stable in 40 % of cases. Sport and recreational accidents had an overall incidence of injury of one in five, of which 71 % were considered to be serious. The three most common types of serious injury were intracranial injury, fractures of facial bones, and vertebral injuries. The most common accident mechanisms were bicycling, horseback riding, and team ball sports, with bicycling causing most frequently serious injury. In conclusion, it is recommended using MDCT to rule out serious injury of the spine and pelvis in adult victims of high-energy accidents of all age groups and both genders, especially in regard to multilevel injuries and injuries of the cervical spine. Even in presumably minor trauma, a high level of suspicion is required, and MDCT should be employed if the clinical finding is uncertain. MDCT is fast, cost-effective, and demonstrates injuries of the spine and pelvis unambiguously, benefiting the trauma patient s outcome.
Source: Työväentutkimus Vuosikirja
Author: Frank V. Bensch
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2191361869